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Northeastern Junior College

Request a Survey

If you would like to have a survey created, please fill-in and submit the form below. If you have any questions, please contact Online Learning at 970-521-6763 or Cyndi Vandenbark at cyndi.vandenbark@njc.edu.

Complete all the fields below for the survey you need.

You will be contacted within 3 days of the date you submit this request. Please have your questions completed before you submit this request. If Online Learning has any further questions, we will contact you by email. Please allow 5 business days for all surveys to launch.

* Denotes required field.

Instructor Information

 
First Name:*
 
Last Name:*
 
Email Address:*
 
Phone Number:*
 
   

Survey Information

 
Survey Type:*


 
If Student survey, which course is this for?
Do you have an e-mail list for this survey?*

 
   
Enter your questions in the box below. Place one questions per line.
There is a 500 character limit in this text box.
   

The questions below are for surveys that have previously been used and need to be re-launched.

Survey to be copied:
Title:
Date:
Do you have an email list for this survey?

Please enter any additional comments or special instructions: